I'm not offended by liberals who call for "incrementalism"doing a little bit now, seeing how it goes, hoping they can do a little more later. Small steps are sometimes prudent. If things go well, they help build the case for something larger. But it's important to remember that incrementalism is a tactic, not a vision. Presidential campaigns should be about where we want to go as a nation, about how much we want to commit. Even if we can't get there all at once, we can at least set our sights high.
In 1996 Dick Morris advised Bill Clinton to think smallV-chips and school uniforms. "Only way to win," Morris told me matter-of-factly, as if he had just gotten the news from an oracle. We'll never know if he was right. But it seems fair to ask: Why win if your ambition is so small? And how important was that particular 1996 victory, when the nation had little or no idea what it was aiming to do in the second term of Bill Clinton's administration? The very lack of a clear mandate from the American people in 1996 may be partly responsible (along with l'affaire Lewinsky) for the dizzying lurch of the White House since then, never stopping long enough to summon the public will in pursuit of a truly large goal.
We're seeing something of the same confusion between goals and tactics in the skirmishes between Al Gore and Bill Bradley. The predictable responses to Bill Bradley's big ideas are that they won't work, they can't be done, and we can't afford them. His health care plan is being nit-picked by policy wonks.
Some wonkish concerns are legitimate. Current enrollees in the federal employees' health care program, on which Bradley bases his plan, are higher paid and generally in better health than the uninsured poor whom Bradley wants to invite in. That means his estimated cost of insuring them may be too low. On the other hand, critics who want to preserve Medicaid miss the point. There's no principled difference between someone who's very poor and eligible for Medicaid and some one who's just poor, but now ineligible. Many move in and out of eligibility as their meager incomes rise slightly and then fall. They and the people above them would do far better in a comprehensive system.
Even at its current scaleroughly $60 billion a yearBradley's plan is at least proportional to the problem it seeks to address, which is to insure 44 million Americans who are now without health care and provide some relief to the millions more who can't afford the premiums they're now paying. The important question isn't whether the plan is perfect. It's whether we as a nation are willing to commit to something as ambitious as this.
In 1994 the nation got scared off health care. Clinton's health plan was bold but also frightfully complicated and easy prey for the Republicans who wanted to intimidate Americans. It went down to bitter defeat, and Bill Clinton never mentioned it again. Pundits predicted that its crash would prevent Democrats from raising the banner of universal health care for at least a decade, if not a generation.
But now here's Bradley with an ambitious plan that's much simpler. You buy private insurance through the same system Congress and federal employees use, and if you're poor, you're subsidized. Want to try again? And while we're at it, let's make the Earned Income Tax Credit bigger, so that if you work, you won't be in poverty. And let's spend some real money on preschool for young children.
These are not radical proposals, and they don't come from a firebrand. The ideas fit comfortably within the liberal-moderate tradition of widening the circle of prosperity as the nation becomes steadily richer. It's the same project we've been carrying out, haltingly, for the better part of a century.
Can we afford them? Of course we can, even if Bradley's health plan costs more than his original estimate. America is extraordinarily wealthy. As the Commerce Department's newly revised growth numbers show, we've become steadily more pro ductive for almost two decades. The economic pie has continued to growregardless of the business cycle, and quite apart from deficits and surpluses. New technologies are transforming the economyrevolutionizing how organizations work, spurring a wave of innovation.
Yet despite this great expansion, we have yet to tackle the nation's unfinished social agenda. Some 44 million people lack health insurance, up from 39 million at the start of the Clinton years. One out of four of our nation's children is impoverished. Many of our schools are literally falling apart.
To limit our ambition to a narrow accounting convention called the "non- Social Security surplus" as currently measured is to declare defeat before we've even begun to make the case for why we should move forward. It puts Republican tactics before Democratic goals and makes incrementalism into a objective for its own sake. There's no reason to adopt this artificial straightjacket, especially when every bit of economic news tells us that we can afford to do far more. With the supply-side deficits of the Reagan-Bush years at last behind us, we can again think big about public needs.